Joint Venture

Our Review Summary

This brief segment summarizes an important randomized trial in which people with knee osteoarthritis fared just as well with nonsurgical treatments such as pain killers and physical therapy as they did when they received these treatments plus arthroscopic surgery. The study confirms findings from an earlier sham-controlled trial showing that people with osteoarthritis of the knee were no better after arthroscopic surgery than after sham surgery.

The segment covers some of this essential information, but not all. Missing are mention of the costs of treatment, which are substantial–and arguably the driving force behind the study; the harms of treatment, which appear to be few and rarely serious; and the fact that people randomized to receive surgery also received nonsurgical treatments.

The newscast also overstates the trial’s conclusions. In an attempt to explain precisely who the findings apply to, it cites an orthopaedic surgeon who wrote the editorial that accompanied the new study. He says that many people who have arthritis “have other problems such as a torn meniscus or a loose piece of cartilage in the knee who may be helped by arthroscopic surgery.” What is the evidence to support this statement? Is it based on findings from a high-quality randomized trial—or the same type of observational evidence that for so long led people to believe arthroscopy was beneficial for arthritis? (Answer: To our knowledge, the latter.) The study’s authors say their findings to not support this view. They write, “Although some may argue that treatment is beneficial for patients with mechanical symptoms of catching or locking or those with early [osteoarthritis]”—i.e., patients with symptoms attributed to meniscal tears or stray bits of “cartilage”—“prespecified subgroup analyses also failed to show efficacy in this population of patients.” The investigators go on to remind readers that their trial intentionally excluded people with large meniscal tears (known as “bucket handle” tears), “in whom arthroscopic surgery is considered an effective intervention.”  Note that the researchers do not say that arthroscopy is “proven” to be effective even in these people.

The researchers’ well-designed and carefully executed trial attempts to answer a very important but specific question. This segment both under-informs and misinforms viewers about its meaning.